With the onset of the Covid-19 pandemic in March 2020, many therapists and counsellors were forced to move their practice online, many for the first time. Though there has been a gradual return to face-to-face sessions, online work is now a much more common and staple part of most counselling and therapy services. And due to ongoing transmission of Covid, for those who are clinically vulnerable remote working may still be the safest option.
As a result, many questions regarding the practice of therapy online have become more and more pertinent. What are the main differences between face-to-face and remote therapies? Are online and telephone sessions as effective? Are they safe and confidential?
Below I look at some of the benefits and challenges of remote therapy conducted via online video platforms such as Zoom as well as over the phone.
One of the benefits of online and and other remote therapies is the potential to increase accessibility for counselling services. Unfortunately it can still be very difficult to find consulting rooms and office space that have good disability access. For those with mobility issues remote therapy can provide an accessible and convenient alternative.
For people who experience high degrees of anxiety, having sessions in their own home might be more comfortable for them. This is especially true when that anxiety manifests in symptoms of agoraphobia in which leaving the house can cause significant distress.
It also improves client choice for people who live in remote areas to have a greater pool of potential therapists to choose from. The quality of the relationship with the therapist is one of the biggest factors in regard to effectiveness, so finding the right therapist to work with is key. Having a bigger pool to choose from gives clients more opportunity to find the right person for them.
The research that’s been conducted so far on the effectiveness of online and other forms of remote therapy suggest that it can be just as effective as face-to-face therapy. In an overview of studies conducted to assess the effectiveness of online therapy, it was found that clients in online therapy ‘experience similar results compared with control groups’, that the ‘working alliance was unaffected by the medium of communication’, and that ‘clients were predominantly satisfied with online therapy’. (1)
One of the most important factors in creating an effective therapeutic environment is the quality of the therapeutic relationship. There has been some concern in the past that remote ways of working would disrupt or prove an impediment to this important feature of therapy. However, research again suggests that this is not necessarily the case.
Whilst more research needs to be conducted, the overall picture so far seems to be that online and remote therapies are not any less effective than face-to-face therapy. Nevertheless, despite not being clearly better or worse, they are different, and there are some unique features of online and telephone therapy that are important to consider.
The disinhibition effect
As with any other form of online communication, online therapy is subject to the same psychological effects that are worth bearing in mind. One of the most common of these is what’s called the disinhibition effect, in which participants in online communication feel less inhibited due to not being in the physical presence of the person they’re communicating with.
Many of us will be familiar with some of the more negative consequences of this in regard to the language, tone, and style of communication seen on things such as online message boards, forums, and comment sections on websites. Communicating online can lead people to be more aggressive in their tone and speech than they would be in person, particularly if they are communicating anonymously.
In therapy, however, this lowering of inhibition can create a calming affect which makes communication feel less stressful. With less inhibition, we may feel more able to talk about sensitive subjects and explore more vulnerable parts of ourselves with our therapist. Being in a comfortable and familiar environment can help us feel more at ease, and feeling generally less inhibited can help us connect to aspects of our inner experience more freely.
Privacy and confidentiality
However, this does not mean that online therapy is right for everyone. A common and understandable concern when it comes to online therapy arises around issues of privacy and confidentiality.
One of the biggest barriers to creating a private and safe environment for online therapy to take place can be the absence of a suitable space in the home. If we are living with friends, family, or a partner, it might be difficult to find a space in the house where we can feel confident of not being overheard. This can be particularly difficult if issues relating to those relationships are things we’d like to work through in therapy.
There are other situations where it may not be safe for someone to conduct a therapy session from their home. In situations of domestic abuse, for example, it is unlikely that the home would be a safe enough environment, and meeting a therapist in person in a separate space may be the much better option.
A common concern also arises around the privacy and safety of communicating online. Thankfully, it is much easier now to find platforms such as Zoom that use encryption to provide safe channels of communication where you can feel confident that no-one else will have access to the call or chat. Whilst no platform is able to provide 100% security, as remote working in general becomes more and more prominent, the security of online communication using tools such as encryption is becoming more effective and reliable.
Online video calls are of course not the only form remote therapy can take. Telephone counselling can be just as effective, though is clearly different in style due to the absence of any body language or non-verbal communication. For those who feel self-conscious with screens or struggle with issues around body image and physical appearance, speaking over the phone may feel like a more comfortable choice.
Speaking over the phone can also provide a feeling of familiarity that, as alluded to earlier, can help reduce inhibition and promote a certain type of flow to conversation. As well as being free to have the session from the comfort of your own home, for some this may help in building rapport and a trusting relationship with their therapist.
No better or worse, just different
Prior to online therapy becoming as prominent and widely practiced as it is now, there was understandable uncertainty and concern regarding it’s effectiveness and suitability. However, as more research has been conducted and more therapists have gained clinical experience, confidence has grown in the ability to form effective and supportive therapeutic relationships using online and remote mediums.
This doesn’t mean it’s suitable for everyone though. For some, the experience of being in the same room as their therapist will remain indispensable, and having a space separate from the rest of their life to engage in therapy may still be preferable for many reasons. But the wider accessibility of online and remote psychotherapy provides further options and possibilities for more people, and serves as an additional and valuable resource in the provision of effective and high quality therapeutic services.
1. Thompson, Ryan Baird, “Psychology at a Distance: Examining the Efficacy of Online Therapy” (2016).
University Honors Theses. Paper 285.